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CASH WISE PHARMACY #15
DSH350011 SANFORD MEDICAL CENTER FARGO
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Covered Entity Details
Entity Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH350011
Entity Address
801 BROADWAY NORTH
FARGO, ND 58102
Medicare Provider Number
350011
Participating Start Date
4/1/2017
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
CASH WISE PHARMACY #15
Pharmacy Address
CASH WISE PHARMACY #3015
3300 HIGHWAY 10 E
MOORHEAD, MN 56560-2512
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tiffany Lawrence, President and CEO, Fargo
(701) 417-2314
Contract Pharmacy Representative
Coborns Inc.
Lynn Young, Director of Pharmacy Operations
(320) 534-2743
Signed By Date
7/14/2020
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